American Society of Nuclear Cardiology review of the ACCF/ASNC appropriateness criteria for single-photon emission computed tomograph myocardial perfusion imaging (SPECT MPI)

Conclusion  The ACCF/ASNC AC for SPECT MPI provides recommendations for the appropriate use of SPECT MPI. After the publication of the AC document in 2005, the AC has been used by nuclear cardiology practices with many clinical studies evaluating the list of indications in routine clinical practice. From these data. ASNC recommends minor but important changes to the indication list, suggesting the addition of 6 new indications and the modification of the definitions for “chest pain syndrome” and “CHD high risk.”. An objective review of existing indications focused on only those indications that had significant variability among the reviewers (n=20). These indications were reviewed in the presence of existing and new evidence-based data, and ASNC recommends that the grades for 6 indications be re-evaluated. The AC for SPECT MPI will require periodic review as new evidence becomes available or as clinical practice evolves. ASNC recognizes the importance of these criteria to improve the quality of patient care, and it will continue to play a key role in assembling the information for this ongoing review. From the current summary of evidence, ASNC consensus opinions, and ASNC recommendations in this document, ASNC strongly recommends that the AC guidelines be reviewed Prepared by the American Society of Nuclear Cardiology Quality Assurance Subcommittee for Quality in Imaging Standards. Reviewed by members of the American Society of Nuclear Cardiology Quality Assurance Committee. Approved by the American Society of Nuclear Cardiology Board of Directors, September 6, 20.     

Cerebral infarction associated with protein C deficiency following allogeneic bone marrow transplantation.

Hypercoagulable states associated with deficiencies in circulating anticoagulant protein C occur after chemotherapy for a variety of malignant diseases. Protein C deficiency also occurs following bone marrow transplantation (BMT) and may be responsible for a variety of transplantation-associated complications. We report the case of a child who suffered a stroke associated with low protein C antigen and activity occurring 11 months after allogeneic BMT. Protein C levels recovered spontaneously by 18 months after BMT. We speculate that the protein C deficiency and and resultant hypercoagulable state led to the stroke, and the deficiency of this anticoagulant was a sequela of the transplant.     

Use of degree-days to time aerial spraying in west-central Colorado.

Seasonal fluctuations in Culex and Aedes were followed from 1984 to 1987 using degree-days (degree Days). The annual population maxima of a "mosquito season" can be predicted. Culex first becomes a problem at about 1,550 degree Days and disappears at 2,675 degree Days. Aedes are present at 525 degree Days, experience a midsummer decline at 900 degree Days, then resurge at 2,400 degree Days to mostly disappear at 2,700 degree Days. This timing appears to work in the arid western valley of Grand Junction, Colorado, due to the dependence by the mosquito on breeding sites related to local irrigation systems, which are dry in the winter and rehydrated at the same time each year.     

Repair of peripheral nerve defects in the upper extremity

Repair of peripheral nerve defects in the upper extremity using end-to-end coaptation is accomplished by one of four techniques: in situ mobilization, rerouting and transposition, joint positioning, and bone shortening. A key concern is the amount of tension generated when nerves are elongated to overcome a gap defect. The evidence indicates that elongation should be limited to 8% to 10% of the original length to avoid neural ischemia. It should be noted, however, that when repairs are delayed, the vascularity of nerves is increased. As a result, compared with acute injuries, chronic injuries will tolerate the same degree of elongation with less neural ischemia despite increased stiffness. The mesoneural attachments along each end of the nerve may be safely stripped to a distance of 8 to 12 cm when mobilizing the nerve. Larger nerves tolerate greater lengths of mobilization than smaller nerves. The maximum amount of mobilization that does not produce ischemia can be expressed as a ratio of the diameter of the nerve to the length mobilized and its value is 1:45. The amount of nerve mobilization required for a secondary repair may be reduced by the initial application of tension to unrepaired nerves, thereby reducing the amount of retraction. As the interval to repair increases, nerve retraction results in up to a six-fold increase in the gap defect that must be overcome. Finally recommendations exist for the repair of peripheral nerve segmental defects in the acute setting.     

Adherence to Daily Oral TDF/FTC for PrEP in Community Health Center Populations: The Sustainable Health Center Implementation PrEP Pilot (SHIPP) Study

AIDS and Behavior - The prevention effectiveness of oral preexposure prophylaxis (PrEP) is highly dependent on medication adherence but no validated longer term PrEP adherence measures are readily...     

Coronary artery bypass surgery for left main coronary artery disease.

The course of 146 consecutive patients with significant occlusive disease of the left main coronary artery who underwent coronary artery bypass surgery during a 4 year period is reviewed. Preoperatively, 11 patients were in New York Heart Association functional class II, 57 in class III and 78 in class IV. Seventy patients had progressive angina and 12 unstable angina. There were two operative deaths (surgical mortality rate 1.4 percent). Seven patients (4.8 percent) had a perioperative acute myocardial infarction. Complete follow-up has been achieved in the surgical survivors over an average period of 18.1 months; 77 percent of the surviving patients are completely asymptomatic and 19 percent are in functional class II. Four patients (2.8 percent) had a nonfatal late postoperative myocardial infarction and five (3.5 percent) died during the late postoperative period (3.3 percent annual mortality rate during a 2 to 47 month follow-up period). Postoperative cardiac catheterization studies performed in 35 patients an average of 12.1 months postoperatively revealed 78 percent of 80 grafts and patency of at least 1 graft in 93 percent of patients. Results of 42 (89 percent) of 47 near maximal treadmill stress tests were abnormal preoperatively compared with results of 14 (26 percent) of 54 postoperatively; in 74 percent of patients having both a preoperative and postoperative stress test, abnormal preoperative test results converted to normal after surgery. This study suggests that direct myocardial revascularization may offer an effective means of improving both the quality and duration of life in a patient with significant occlusive disease of the left main coronary artery.     

Morphometric observations on the effects of ischemia in the isolated perfused rat heart.

The design of the experiment was to observe the changes which took place in the isolated perfused rat heart, that was made ischemic according to the technique of Neely et al. [16], using quantitative stereological techniques. The results showed that 24 min after myocardial failure there was a significant decrease in the fractional volume of myofibrils, mitochondria, T-system, and sarcoplasmic reticulum. The decrease in fractional volume of subcellular organelles can most probably be explained by myocardial cell swelling secondary to intercellular edema. There was also a decrease in the sarcoplasmic reticulum membrane area, and quantitative measurements indicated that this compartment was dilated. Observations on the intercalated disc indicated that there was a migration of acid phosphatase positive multivesicular bodies toward the disc interspace in ischemic hearts. This was found to be associated with the dissolution of gap junctions. Stereological measurements indicated that in ischemic hearts there was a 5-fold increase in the percentage of membrane area of the disc made up of open gap junctions, and that the number of vesicles from multivesicular bodies observed per μm³ of disc interspace was also proportionately higher. It is suggested that the multivesicular bodies represent elements of the lysosomal system and are responsible for the dissociation of the intercalated disc in ischemic hearts.